3 



257 
3 
3y 1 




THE SOLUTION 



THE MILK PROBLEM 



GEORGE LLOYD MAGRUUER, A.M., M.D., 

EMERITUS PROFESSOR OF MATERIA MEDICA AND THERAPEUTICS. SCHOOl, OF 
MEDICINE, GEORGETOWN UNIVERSITY, WASHINGTON, D. C. 



THE SUSCEPTIBILITY OF PERSONS TO ATTACKS BY DISEASE 
GERMS DIFFERS GREATLY. 

THE SUSCEPTIBILITY OF THE SAiVIE PERSON TO DISEASE GERMS 
DIFFERS GREATLY FROM TIME TO TIME. 

AS THERE IS NO WAY TO MEASURE THE SUSCEPTIBILITY OF 
DIFFERENT PERSONS, OR OF THE SAME PERSON AT DIFFERENT TIMES. 
IT IS DANGEROUS FOR ANY PERSON TO EXPOSE HIS HEALTH TO 
DISEASE GERMS AT ANY TIME. 

EXPERIENCE HAS SHOWN THAT INFANTS AND INVALIDS ARE EX- 
CEPTIONABLY SUSCEPTIBLE TO THE ATTACKS OF DISEASE GERMS; 
HENCE THEY, ABOVE ALL OTHERS, SHOULD HAVE PURE, CLEAN, 
GERM-FREE MILK. 



1913. 

PUBLISHED BY R. BERESFORD, 605 F STREET, N. W. 

WASHINGTON, D. G. 



COPYRIGHT, 1913, 
By GEORGE IJ^OYD MAGRUDER, A. M., M. D. ^/ 



Price, 10 Gents, 



DEPARTMENT OF AGRICULTURE. 

office: of the secretary, 

Washington. 

January 2j, 19 13. 
Dr. G. Lloyd Magruder of Washington, D. C., is peculiarly qualified 
to write a publication on milk. The people should have pure water and 
pure milk. Dr. Magruder is identified in the City of Washington with a 
thorough study of both. He stands high as a medical practitioner and 
instructor, and whatever he offers to the public is certain to be well worth 
reading. 

James WhvSon, 

Secretary. 



©CI,A334290 

If r / 



^^v 



MILK UNDER THE GUISE OF ITS INNOCENT WHITE COLOR OFTEN 
HIDES THE PRESENCE OF DANGEROUS GERMS. 

Milk must be produced by healthy cows. 

Milk must be clean. Germs are few in clean milk. 

Milk must be promptly cooled and kept cold. The growth of germs is 
checked by cold. 

Milk must be properly pasteurized, promptly cooled, kept cold and covered 
until delivered to the consumer. 
These conditions secure absolutely safe milk. 
These conditions, without pasteurization, secure reasonably safe milk. 

Milk delivered in good condition to the consumer soon spoils unless kept 
covered and cold. 

Dirt and germs in milk are danger signals and warnings against raw milk. 

Many diseases are caused by bacteria. Bacteria in milk are made harmless 
by heat. 

Water with 2,000 bacteria to the teaspoonful or with colon bacilli is sus- 
picious, and should be boiled before being used for drinking purposes. 

Everybody knows that a water supply contaminated with sewage is a dan- 
ger to Public Health. 

Much market milk is more contaminated with germs than the sewage of 
many large cities. 

CONTAMINATED MILK IS MANY TIMES MORE DANGEROUS THAN 
CONTAMINATED WATER, BECAUSE DISEASE GERMS WHICH 
WOULD STARVE IN WATER RAPIDLY MULTIPLY IN MILK. 

Typhoid Fever is so rare in Munich, a city with a good water supply, well 
sewered and where all milk is boiled, that medical teachers are hardly 
able to secure subjects for demonstrating the disease to medical 
students. 

Bacteria are not removed from milk by filtering. 

The price of milk to the producer and the distributor should be determined 
by the cream, solid contents and the purity. The purity is deter- 
mined by the character and number of bacteria in it. 

Excessive numbers of bacteria show that milk is old, dirty, or produced 
under improper conditions or by unhealthy cows. 

Fortunately the public is heeding the teachings of sanitarians and is seek- 
ing protection by purchasing milk from producers and dealers who 
recognize that milk must be free from an excessive number of any 
bacteria and from all disease-producing germs. 

SAFE MILK SAVES BABIES AND DIMINISHES THE PREVALENCE 
OF TUBERCULOSIS, TYPHOID FEVER, DIPHTHERIA, SEPTIC 
SORE THROAT AND OTHER DISEASES. 



INTRODUCTION. 

Today there is not a shade of doubt that impure raw milk and cream 
are prominent factors in keeping up tha prevalence of Tuberculosis, 
Typhoid Fever, Scarlet Fever, Diphtheria, Infantile Diarrhea and other 
diseases and impaired physical conditions that have been positively traced 
to Contaminated Milk. 

The continued high mortality of adults and infants from these pre- 
ventable diseases can be enormously reduced by heeding the teachings of 
modern sanitarians. This education must commence at the farm, and be, 
continued to and include the consumer. There must be cooperation by 
every one who handles milk to protect it from contamination. The 
public must pay for this care. The farmer must give a better product 
for the increased price that he must receive. Dirty milk should not be 
bought at any price. 

It is the object of this booklet to show the farmer and the consumer 
zvhy safe milk is necessary and how it can be secured. 

During the last few months the subject of the Dangers from Con- 
taminated Milk and the Methods of Prevention have attracted unusual 
attention from physicians and others interested in the conservation of the 
public health. It is now generally conceded that clean, cold and properly 
pasteurised milk is one of the important means, if not the most important 
factor in reducing disease and death. These conditions furnish safe 
milk for everyone. It is the easy and safe solution of the milk problem. 

To secure this much-desired safe milk vigilance is required from the 
farm to the consumer. Fortunately, these requirements are simple and 
can be complied with at small additional expenditure of time and money. 
Circulars 131 and 170, Bureau of Animal Industry, Department of Agri- 
culture, positively confimi this statement. Both time and money are 
necessary and must be supplied. The addition of one or two cents a 
quart should furnish every safeguard. Milk at nine cents a quart should 
come from herds that do not show any physical signs of disease upon 
careful and frequent inspection, and it should be clean, cold and properly 
Pasteurised. Milk at 10 cents a quart should insure the additional 
safeguard of being furnished from tuberculin-tested cows, and being 
properly capped to protect against dust. 

The farmer should receive a due proportion of this increase in price. 
No safe milk can be produced under the conditions and at the prices 
that prevailed previous to 1907, the date that the Washington Milk Con- 
ference demanded better conditions and recommended the advances in 
the price of milk. Since then it has been repeatedly shown that the addi- 
tional price of one cent per quart to the farmer will secure high-grade 
milk with very low germ contents. 

Encouraged by the reception of my writings and addresses, the results 
of my former efforts in behalf of pure water and pure milk, and the 
influence for good of the work done here in Washington by persons in 



official and private life, it seems that the time is opportune for presenting 
in everyday language the facts in regard to milk, that the dangers may 
be understood and the remedial measures may be applied. 

This is desirable because even yet, notwithstanding the indisputable 
evidence that has been presented, there are many persons of intelligence 
who seem to ignore these dangers and still use and permit those under 
their charge to use poisonous milk. This is notable in schools, hospitals, 
infant asylums and hotels and other eating places. 

Many publications relating to milk have been issued by the Govern- 
ment. They can be secured from the Government Departments, Mem- 
bers of Congress and the Superintendent of Documents, Government 
Printing Office, Washington, D. C. These publications have been pre- 
pared by persons in public and private life, sometimes as monographs and 
sometimes by conjoint work. They have had a world-wide influence for 
good. They frequently have served as the basis for national, state and 
m.unicipal authorities in framing legislation and regulations for the 
proper production and distribution of milk and dairy products. They 
are repeatedly quoted by writers in this country and abroad, and have 
furnished most valuable data for them. 

SOME GOVERNMENT PUBLICATIONS IN REGARD TO MILK. 

Six of the most important of these publications, with the issue of which 
I was intimately associated, are: 

1. "Report on Typhoid Fever in the District of Columbia," submitted 
by the Medical Society of the District of Columbia to the Committee 
on the District of Columbia of the United States House of Representa- 
tives, June 14, 1894, and published by Congress as a congressional docu- 
ment in 1894. This report was prepared by a committee, appointed upon 
my motion, and of which I was chairman. 

The conclusions and recommendations of the Committee of 1894 are 
accepted as authoritative today. 

Recommendations 9 and 10 attracted much attention. 

Recommendation 9 : 

" Careful inspection of all dairies in the District from which our milk supply is 
drawn, and the enactment of a law by which no milk shall be sold in the District 
without a permit from the Health Office. The inspection should cover an exami- 
nation at the dairies of all possible sources of infection, including the water supply." 

Recommendation 10 : 

"The urging on the members of the profession of a careful collation of all facts 
bearing on the mode of infection in each case, and the advantage of reporting such 
facts to the Society, and the propagation of the doctrine that immediate disinfection 
of the stools is the first duty of the physician as guardian of the health of the 
community." 

The results of this report were that the District Cotnmissioners and 
Congress sought the aid of the Medical Society and individual members 
in framing the law governing the milk supply of the District. 

The present attention given the pollution of water by sewage, and the 
contamination of oysters, thereby accentuates the Committee's recom- 



mendation to promptly and thoroughly disinfect the discharges from 
typhoid-fever patients. 

2. " Sanitary Milk Production." Report of a Conference appointed 
by the Commissioners of the District of Columbia. Issued August 20th, 
1907, by the U. S. Dept. of Agriculture, as Circular 114, Bureau of 
Animal Industry. This Conference was called upon the suggestion of 
Mr. E. Berliner and with my cooperation. The report was published, at 
my request, by the Department of Agriculture. 

This circular contains the Melvin Classification for Milk, and is fre- 
quently quoted, and has time and again served as the basis of State and 
municipal regulation and legislation. The London Lancet. 1907, Vol. 
II, No. 13, says (alluding to Circular 114) : 

" This volume will be the recognized text-book of the health authorities of this 
country for the present. * * *" 

3. " Milk and its Relation to Public Health." Issued Jan., 1908, by 
the Treasury Department, as Bulletin 41, of the Hygienic Laboratory of 
the Bureau of Public Health (revised Jan., 1910, as Bulletin 56), 

This publication is the direct result of my personal appeal to Theo- 
dore Roosevelt, then President of the United States. It is looked upon 
as the most complete work ever published on milk. The Neiu York 
Medical Record considers Bulletin 56 as the most valuable work ever 
issued by the Government on health matters. It was the conjoint work 
of the Bureau of Public Health, the Department of Agriculture and the 
Health Officer of the City. It shows the great value of cooperative work. 

In June, 1909, the Secretary-General of the International Institute of 
Hygiene told me. in Paris, that " this Bulletin was the best book in the 
world upon milk." The Countess of Aberdeen, during her recent visit, 
stated to me that " Sir William Osier had informed her that Bulletin 56 
would give her all needed information upon the milk problem." 

4. " The Dissemination of Disease by Dairy Products and Methods of 
Prevention." Issued April 28th, 1910, as Circular 153, Bureau of 
Animal Industry, Department of Agriculture. This publication is the 
amplification of the paper which I presented at the International Medical 
Congress at Budapest in 1909. 

This circular has also been highly esteemed and has helped to secure 
appropriate legislation governing the milk supply. The London Lancet, 
June 25th, 1910, pp. 1768, 1769, in an editorial upon Circular 153, says: 

" The Circulars of the Department of Agriculture have one special feature in 
common apart from their high scientific value, and that is their clearness. * * * 
This report is of particuar interest in that it shows how strong is the feeling in 
scientific circles in America as to the danger of contracting tuberculosis from 
milk." 

5. " Report of the Commission on Milk Standards appointed by the 
New York Milk Committee." Reprint from Public Health Reports. 
Issued May 10th, 1912. 

This Commission was appointed as the result of a motion submitted by 
Dr. E. C. Schroeder, Mr. E. Berliner and myself, at the Conference in 
New York Called by the New York Milk Committee December, 1910. 
This report shows that the Commission amplified the Melvin Classifica- 
tion adopted by the Washington Milk Conference in 1907. A majority 



of the Commission iva-s in favor of pasteurisation of the entire milk 
supply. This Commission was composed of some of the most prominent 
sanitarians of this country. 

6. " Report of A Special Committee appointed by the Washington 
Chamber of Commerce to investigate the Milk Situation in the District 
of Columbia." Senate Document No. 863, 61st Congress, 3d session. 
This is a most valuable work and is full of authoritative information. 

The last five publications, all issued during and since 1907, give an 
idea of some of the health activities of the United States Government 
in relation to the milk supply. They show the promptness and readiness 
of the officials of the Department of Agriculture and the Bureau of 
Public Health to cooperate for the public welfare. Millions of copies of 
these and other most valuable Bulletins and Circulars of great educa- 
tional value towards controlling and eradicating preventable diseases and 
conserving the purity and abundance of food supplies have been pre- 
pared and issued by officials of these two Departments, as well as other 
Departments of the Government. 

FREE USE OF SAFE MILK ADVOCATED. 

All the warnings as to the necessity of care in the use of ordinary 
market milk have been fully justified and the use of it was properly 
restricted. Now, if the teachings of today are heeded, unlimited use of 
it can be resumed with mutual advantage to the producer, distributor and 
the consumer. The farmer and the distributor must be paid for their 
efforts to comply with modern requirements. The consumer will receive 
safe milk for his additional outlay. The additional outlay by consumers 
will be much less than the cost of sickness and funerals caused by unsafe 
milk. 

MILK AS FOOD. 

Milk and its Products — cream, ice-cream, butter, buttermilk and 
cheese — are among the most important articles used for human food. 
They furnish quite one-sixth of the food used by mankind. The pro- 
ducts are liable to the same risks of contamination as milk itself, hence 
are equally dangerous when contaminated. 

Milk is the most generally employed article of diet for infants and 
children. It is extensively used in homes and hospitals as a part or the 
whole of the diet for the well and the sick. 

CONSTITUENTS OF MILK. 

Milk Furnishes the Elements essential to the sustaining of life 
and the growth of the body. These ingredients are the protein com- 
pounds, fats, carbo-hydrates and mineral matters. 

Protein Compounds are the albuminous contents — casein or curd, 
lactalbumin and lactglobulin. They correspond to the lean of meat and 
the white of eggs. They make muscle, bone and blood. 

The Fat, after standing, rises to the surface and is known as cream. 
This corresponds to the fat of meat and oil. It yields heat and muscular 
power. 



The Carbo-hydrate; is present in the form of milk sugar. It corre- 
sponds to the starch of cereals, and, like the fat, yields heat and muscular 
power. 

The Mineral Matter is composed of combinations of lime, potash, 
sodium and other chemical elements, which are essential for the building- 
of the human body. 

CARRIER OF DISEASE. 

For years physicians and others interested in the public health have 
demonstrated that this beneficent fluid also was a carrier of disease. 
Repeated appeals were made to national. State and municipal authorities 
to remedy this condition. 

As early as 1873 Congress was urged by the authorities of the District 
of Columbia to provide for inspection to improve the milk supply of the 
city. These appeals to the authorities apparently fell upon deaf ears 
until the summer of 1894. It is true, the year before, 1893, Dr. Coit, 
of Newark, N. J., did succeed, after repeated efforts for several years 
preceding, in inducing the State Medical Society of New Jersey to 
appoint the Essex County Medical Milk Commission. This Commission 
arranged with the proprietor of a dairy to produce milk according to 
the requirements and under the supervision of the Commission. This 
milk was known as " Certified Milk." 

Milk commissions are voluntary associations formed for the purpose 
of securing better milk for infants and invalids. There are now in the 
United States 73 milk commissions. The requirements for certified milk 
are ideal. Constant vigilance by the highest grade of intelligent em- 
ployees is essential to carry out these requirements. This vigilance is 
not obtainable for lengthly periods. With all precautions exercised, there 
are frequent reports of contaminated milk being served by certified 
dairies. 

This is true to so great an extent that many prominent members of the 
Association of the American Medical Milk Commissions, who formerly 
believed that raw milk was a much better food for infants and invalids 
than pasteurized or boiled milk, now openly admit that no milk is safe 
for use until after it has been exposed to a sufficient degree of heat to 
kill disease germs. 

The influence of medical milk commissions in securing an improvement 
in the general milk supply has been very great, exceptionally so since the 
organization in 1907 of the Association of American Medical Milk 
Commissions. Unfortunately the requirements for producing certified 
milk are so exacting that the cost of the product is beyond the means of 
the masses. 

THE MILK LAW OF 1895. 

The first important step in the legal control of the milk supply was 
initiated in Washington in 1894. It required the occurrence of cholera 
in Hamburg and its appearance upon a ship from that port in the harbor 
of New York to arouse the attention of Congress to the dangers lurking 
in milk. This resulted in the passing of the law, approved March 2d, 
1895, which provided that no milk should be sold in Washington without 



9 

a permit from the Health Officer, and that such a permit should not be 
issued until after an inspection of the conditions at the farm, including 
the water supply. These requirements were those suggested in Recom- 
mendation 9 of the report made the year before by the Committee of 
the Medical Society upon the Causes and Prevalence of Typhoid Fever. 
This law gave Washington the honor of being the first city in the coun- 
try, if not in the world, to have legal requirements for its milk supply. 

WHY SAFE MILK IS NECESSARY. 

Chemical examinations and bedside observations had shown, time and 
again, that milk was the cause of serious outbreaks of a number of 
-diseases and the increased death rate therefrom. It was also shown that 
malnutrition, disease and death also resulted from much of the milk used 
for infant feeding. 

RESULTS OF BACTERIOLOGICAL INVESTIGATIONS OF 

MILK. 

To bacteriology, which by this time had made great progress, the world 
is indebted for the positive knowledge of the xauses of many diseases. 
Bacteriology has shown that these diseases are the direct result of spe- 
cific bacteria. Bacteria grow with amazing rapidity in milk, since milk 
furnishes the most favorable conditions required for their growth. 
Bacteria are commonly knozvn as germs. They belong to the vegetable 
kingdom. In fact, they are minute plants which cannot be seen without 
the aid of a powerful microscope. They appear in nature in three forms, 
the spherical, the rod-like and the spiral. The spherical are commonly 
known as cocci, these include the streptococcus, the staphylococcus and 
other cocci. The rod-like group are called bacilli, and include the typhoid, 
tubercule, colon and diphtheria bacillus. The spiral group are called 
spirilla and spirochaeta. 

Bacteria, like visible plants, may be harmless or deadly. We have the 
harmless and nutritious mushroom and the deadly toadstool. We have 
the harmless and valuable nitrogen-producing bacteria which contribvite 
so much to the growth of plants and the deadly germs of tuberculosis and 
typhoid fever. 

GROWTH OF BACTERIA. 

Under favorable conditions bacteria attain maturity within an hour. 
Milk is an ideal medium for' their growth. Their multiplication is accom- 
plished by the simple process of transverse division, that is one bacterium 
becomes two, two become four, four become eight, and so on indefinitely. 

Bacteria do not grow rapidly in pure water, but they do survive in it 
for various periods and promptly grow when subjected to favorable 
conditions. 

In Raw Market Milk as many as one billion and a quarter germs 
have been found in a single teaspoonful. The sample was taken from a 
wagon on a regular round in the summer-time. In a level teaspoonful 
of ice cream over two billion germs have been found. Imagine the pos- 
sible result if many of these had been disease-producing bacteria! 



lO 



Below 50 degrees F. the growth of many bacteria is checked, but they 
survive even below the freezing point. Above 50 degrees F. they begin 
to multiply and multiply with marked rapidity as the warmth increases. 
When the temperature increases above 100 degrees F. the various 





Culture plate from milk carefully drawn 
from washed cow, handled in a sanitary man- 
ner and kept at 50° F. Only a single colony, 
and but 500 bacteria per cubic centimeter. 



Culture plate showing bacteria in milk not 
cooled, kept at 60°F. for twenty-four hours. 
Numerous colonies; 2,800,000 bacteria per 
cubic centimeter. 



varieties begin to die. As the result of investigations by men of the 
highest authority the world over, it has been found that all disease-pro- 
ducing germs commonly present in milk, technically called pathogenic, 
are killed at a temperature of 140 degrees F. maintained for twenty 
minutes. This degree of heat and time of exposure do not in any way 
destroy either the chemical or nutritive properties of milk, nor do they 
alter the taste, nor do they destroy the cream line. There . is no per- 
ceptible alteration in the milk. 

OFFICIAL INVESTIGATION OF THE EFFECTS OF COLD AND 

HEAT UPON MILK. 

The Department of Agriculture is at present conducting an investiga- 
tion into the effects of temperature, from the freezing point and below 
to the boiling point, as to the chemical and nutritive properties of milk. 
The report of this investigation will be of great value. German authori- 
ties have claimed that no ill effects have resulted from freezing milk. 
Information available in the Bureau of Animal Industry confirms the 
claims of the German authorities and of the above facts as to the influence 
of heat at 140 degrees F. for 20 minutes. 

SOURCES OF BACTERIA IN MILK. 

Men of high authority on the properties of milk maintain that milk 
may be free from bacteria when secreted from the healthy cow. Milk 
is rarely, however, found free from bacteria. Disease or injury to the 



II 

udcler or bag of the cow is accompanied with the presence of bacteria. 
Some diseases of cows are accompanied with the discharge of germs in 
the milk. Bacteria even penetrate into the small openings of the cow's 
teat, but do not extend very far into the udder. The possible danger 
of contamination from this source can easily be largely averted by not 
collecting the first few streams of milk, which is known as fore milk. 

The contamination of milk occurs from many outside sources : dirt 
and dust in the air of the stables, dirt and dust from the body of the 
cow falling into the milk pail, and dirt from the clothing and hands of 
the milkers. 

This dirt and dust convey many bacteria : the dirt from the body of 
the cow is exceptionally dangerous, as much of it is cow manure, and the 
dirt from contaminated pools in the barnyards and pastures, which con- 
vey to the milk the colon and streptococci germs. The colon bacilli in- 
variably conies from the intestinal canal of man or beast. Their pres- 





Dirty sediment in bottom of bottle of milk. 



Milk sediment magnified. This sediment 
consists of cow dung, hair, bacteria, etc. 



ence indicate contamination with fecal discharges. Recent studies have 
demonstrated the existence of virulent bacteria stored under the finger- 
nails of persons handling food products. Keeping the nails short, and 
careful washing of the hands with the nail brush before milking, will 
eradicate this source of infection. Flies are a common source of con- 
tamination. From the habits of the fly this source of contamination is 
most dangerous. Screens should be used to prevent access to privies and 
thence to milk houses. 

The Pails, Cans and Bottles used in the process of preparing and 
distributing milk are a constant source of contamination. Unless, before 
being used and being filled, these are scrupulously cleaned with boiling 
water, a potent source of contamination is furnished. Cold water should 
never be used in the final cleansing of milk utensils. A visit to the 
average distributing depot or dairy will show that here, too, are mani- 
fold and prolific sources of milk contamination. 



12 

BACCILLUS CARRIERS. 

Bacteriology has shown within the last few years that persons fre- 
quently carry in their systems germs of the disease for years after having 
recovered from a germ disease. Cases are on record of severe out- 
breaks of typhoid fever being traced to handlers of milk who had had 
the disease many years before. Such persons are known as " Baccillus 
Carriers." It is also true that many persons have been known to harbor 
virulent bacteria of diseases, such as diphtheria, pneumonia and others, 
without ever having suffered with the disease themselves. Fortunately, 
the human system is endowed with powerful resistance to the attacks of 
harmful bacteria. It is when this resisting pozvcr is lozv that direful 
results ensue. 

THE WATER SUPPLY OF DAIRY FARMS. 

In the fall of 1906, at my request, bacteriological investigations, the 
first extended series of their kind on record, were made of the water 
supplies of 60 dairy farms, taken, without selection, in Maryland, Vir- 
ginia and the District of Columbia, by the Department of Agriculture. 
The revelations of contamination were startling. In the winter and spring 
of 1907 290 more water supplies were examined with equally astounding 
results. The bacteriological examinations of the water supplies of the 
first 60 dairy farms showed that only 25 per cent, were under the danger 
line — that is, if we take 500 bacteria to the cubic centimeter (15 drops) 
of water as the limit of safety, 30 per cent, were suspicious, having above 
500 bacteria to the cubic centimeter, and 45 per cent, were unfit for use, 
as they showed the presence of sewage bacteria. The bacteria counts 
in some instances were as high as 27,000, though they were made in 
November and December — that is, in comparatively cold weather. 

Since these bacteriological examinations were made similar examina- 
tions have followed in other cities, with almost identical results. 

No community would permit the use for any extended period of a 
contaminated water supply. Every careful householder should boil the 
water until remedial measures were furnished. Millions have been spent 
to purify zvater supplies of cities. Why should not the same concern be 
exercised in regard to a contaminated milk supply? The dangers are far 
greater. 

In the Report of the Secretary of Agriculture for 1912, on page 139, 
it is stated: "Simple directions for the improvement of farm-tvater 
supplies have been formulated." This is a most important and valuable 
announcement. 

DISEASES PRODUCED BY CONTAMINATED MILK. 

It has been found that a number of diseases, namely, Tuberculosis, 
Typhoid Fever, Septic Sore Throat, Diphtheria, Scarlet Fever and 
Intestinal Disorders of Infants, have been positively traced to the germs 
found in milk. Some of these have been derived from the cow, others 
have found their way into milk through human agencies. It will suffice 
to consider sorne of these germ-produced diseases. 



13 

TUBERCULOSIS. 

Tuberculosis is the one disease the germs of which enter milk ahnost 
exclusively from the cow. Upon rare occasions the germ enters the milk 
from the coughing, sneezing or carelessness of a milker affected with 
the disease. Tubercle bacilli are secreted in the milk when there is 
tuberculous disease of the udder. Frequently milk is found contaminated 
with tubercle germs for some time before the disease is detected in the 
cow from which the milk was obtained. The commonest source of con- 
tamination is in the discharge from the bowels of cows affected with the 
disease. This cow dung falls into the pail from the flanks, udder and 
tail of the cow at the time of milking. They do not multiply in milk, 
but they do survive and do grow when subjected to favorable conditions. 
Neither the processes of making ice cream nor butter destroy them. 
Schroeder found them virulent for guinea pigs in butter made from 
contaminated cream, which butter had been kept in storage for 161 days. 
Three out of four hogs, weighing over 150 pounds, fed two ounces of 
butter per day for thirty days, were found to have contracted tubercu- 
losis. Butter from raw cream is often contaminated with tubercle germs. 
Cream is found to have many more germs than milk, since the germs 
adhere to the fat globules and rise to the surface with them. The 
Department of Agriculture found tubercle germs in the refuse from 
the separators in 33 per cent, of the creameries examined. This start- 
ling revelation warns that skimmed milk should not be used for man 
nor beast in a raw state. Tubercle bacilli are frequently found in 
market milk. The Bureau of Animal Industry has shown that from five 
to twe*ity-five per cent, of dairy cows responded to the tuberculin test. 
Tests made in 1907 of a large proportion of the herds supplying milk to 
Washington showed that 17 per cent, of the cows reacted. 

To Robert Koch we are indebted for the discovery that the Great 
White Plague, in its various manifestations in man and beast, is due to 
a germ known as the tubercle bacillus. For years he maintained that 
the germs for man and beast were identical. In 1901 he promulgated his 
opinion that the bovine tubercle bacillus was harmless to man. At once 
this statement aroused great interest. Numerous investigators gave much 
study to the question. Now it is almost unanimously maintained that 
this opinion, announced by Koch in London in 1901, and reiterated at 
the International Congress on Tuberculosis in Washington in 1908, was 
wrong. 

The work of Schroeder and Cotton on this subject attracted universal 
attention. (See Bulletin 99, May 11th, 1907, and Circular 118, Dec. 
21st, 1907, Bureau of Animal Industry. Department of Agriculture.) 
They demonstrated that tuberculous cattle discharged tubercle germs 
from their bowels ; that these germs have their origin principally in the 
lungs, are coughed up, swallowed and then discharged in still virulent 
form with the feces. They also demonstrated that " The cattle that pass 
tubercle bacilli per rectum are not always visibly diseased. Many ap- 
parently healthy but tuberculous cattle which are not known to be 
tuberculous until they are tested with tuberculin, intermittently pass 
tubercule bacilli from their bodies per rectum with their feces." 



14 

Some of these cows were affected with tuberculosis of the udder and 
secreted tubercle bacilli in their milk. Several hundred guinea pigs were 
inoculated with this milk in a raw state. Every one of them showed 
general tuberculosis. Over 200 guinea pigs were injected with milk 
from the same cows after it was pasteurized for 20 minutes at 140 
degrees F. Not one of these showed any signs of tuberculosis. 

The investigations made relative to the use of pasteurized milk from 
tuberculous cows and from cows actually affected with udder tubercu- 
losis, prove that it has no objectionable influence on the body and that 
it does not injure the health in any determinable way. 

The safety secured by pasteurizing the milk is a very important fact 
from an economic standpoint. The milk of every one of these apparently 
healthy cozvs could be used zuitli absolute safety in the raising of children, 
calves and hogs, and for household purposes after being brought to and 
held at the proper heat for the destruction of the tubercle germ. No 







:^^^p^g 




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fll^^ 




^^ ^ 


li)^^S|P<r~^ ^fe 


§. 




f^%<^^m%.^ 




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i -<'^3^>«^'^^IIkJh 


t- 


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An apparently healthy but dangerously tuberculous cow. Her milk, after it has been properly 
pasteurized, is safe. Hence it is not necessary to kill her. 

complicated apparatus is necessary to accomplish this much-desired re- 
sult. What a boon to mankind if this fact would be accepted and applied ! 
The farmer, in time, would thus secure a healthy herd and healthy hogs. 
His resources would be promptly augmented. There would be less de- 
struction of live stock and condemnation of food products derived from 
this source. The experiments and conclusions derived therefrom by 
S'chroeder and Cotton have been repeatedly confirmed. " The practica- 
bility of eradicating bovine tuberculosis and of building up herds of 
sound animals from the progeny of tuberculous cattle zms demonstrated 
at the Ohio Experiment Station of the Department of Agriculture. 
(Report of Secretary of Agriculture, 1912. page 99.) 

The British Royal Commission to inquire into the relation of human 
and animal tuberculosis confirmed the experiments of Schroeder and 
Cotton in every particular, and so reported in January, 1909, in its 
" Third Interim Report." Their report was based on the information 
obtained from these repeated experiments. 

Influenced by this report the Board of Agriculture and Fisheries of 
Great Britain issued in May, 1909, " The Tuberculosis Order of 1909." 
This order provided that after January 1, 1910, milk sold in Great 
Britain should come from tuberculin-tested cows, or should be sterilised. 
These twoparagraphs from this order are very positive: 



15 

"As your local authority are doubtless aware, the subject of tuberculosis in 
rnan and in animals, and the relations between the disease in human beings and 
in animals, has been under careful investigation during recent years in this 
■country and abroad, and various phases of the question have been inquired into 
by successive royal commissions. So far as regards the possibility of the trans- 
mission of the disease from affected bovine animals to man, the board are satis- 
fied that it must now be accepted as a fact that tuberculosis is transmissible by 
the agency of milk used for human consumption. The Local Government Board 
concur in this view, and a bill was introduced in the House of Commons by the 
President of the Local Government Board on the 25th inst. designed, inter alia, 
to afford protection to the public health from the risk of the spread of tubercu- 
losis by the means of milk used for human consumption. 

" In considering the question in relation to animals, the fact that the disease 
is communicable to man by milk has a material bearing on the measures to be 
adopted. Any action which results in the reduction in the number of tubercu- 
lous bovine animals in the, country must reduce the risk of the spread of tuber- 
<;ulosis amongst the comrnunity, and if it were possible to eradicate from this 
country the disease in animals, a material step forzvard zvould have been taken 
in the campaign against the disease in man." 

The position of the British Royal Commission as to the material bene- 
fit to mankind of the control of the tubercle germs in milk is sustained 
and strengthened by the data taken from a publication of the Research 
Laboratory of New York City, based on 1,330 cases of tuberculosis 
examined by Park and Krumweide. 

The following table graphically shows the data : 

Percentage Frequency of Tubercueosis Caused by Infection with 
Tubercle Bacilli from Tuberculous Cows. 



Diagnosis. 


Adults 

1 6 years 

and over. 


Children 

5 to i6 
years. 


Children 

under 
5 years. 


Pulmonary tuberculosis, 

Tuberculosis adenitis, cervical, . . . . 

Abdominal tuberculosis, 

Generalized tuberculosis, 

Tubercular meningitis (with or with- 
out generalized lesions), 

Tuberculosis of bones and joints, . , . 


per cent. 
O.O 

3-6 

22. 

2.7 

o.o 
3-5 


^er cent. 
O.O 

36.0 

46.0 
40.0 

0.0 
7-3 ■ 


per cent. 

4.1 

58.0 

59-0 
23.0 

13.6 
0.0 



Reliable evidence has shown that more than 35 per cent, of all cases of 
tuberculosis in children under 16 years of age are of bovine origin, and 
I31/2 per cent, of fatal cases of tuberculosis among children under five 
years of age are due to bovine tubercule bacilli. These facts have so 
impressed the authorities of France that it has been recommended, with 
a view of saving the infants of France from tuberculosis and diarrhoel 
diseases, that all milk be heated to 176 degrees F. Disease germs in 
milk heated to 176 degrees F., even for a few minutes, will be killed. 



There are the disadvantages that at this temperature the cream Hne is 
destroyed and the mjlk acquires a cooked taste. The available evidence 
gives us no reason to beHeve that these changes are accompanied by a 
lessening of the food value or the digestibility of the milk. This tem- 
perature of 176 degrees F. has been selected because it is known to be 
beyond the death point of disease-producing germs, and a test is available 
to ascertain promptly whether such a temperature has been used with 
the milk. The test is derived from the fact that the chemical Para- 
paphenylenediamine (for short, called the Para Test) immediately 
changes the color of the milk to blue, if it has not been heated beyond 
175 degrees F. 

The Washington Association for the Prevention of Tuberculosis gave 
especial attention to milk as an important phase of the tuberculosis situa- 
tion at two meetings m 1912. Strong resolutions positively endorsing 
the necessity of the pasteurization of the entire milk supply by the holding 
process were adopted. Amongst others, the following persons discussed 
and voted for the resolutions : 

George M. Sternberg, Surgeon General, U. S. A., Retired; 

Dr. Harvey W. Wiley, Chemist and Chief Bureau of Chemistry, U. S. 

Department of Agriculture ; 
Dr. E. C. Schroeder, Superintendent Experiment Station, Bureau of 

Animal Industry ; 
Dr. R. W. Hickman, Chief of Quarantine Division, Bureau of Animal 

Industry ; 
Dr. George M. Kober, Professor of Hygiene and Dean of Georgetown 

University Medical School ; 
Mrs. John McLaughlin; 
Dr. [esse Ramsburgh ; 

Dr. A. D. Melvin, Chief of Bureau of Animal Industry, U. S. Depart- 
ment of Agriculture ; 
Dr. John R. Mohler, Chief of Pathological Division, Bureau of Animal 

Industry ; 
Dr. Wm. C. Woodward, Health Officer, District of Columbia ; 
Dr. G. Lloyd Magruder, Emeritus Professor oT Materia Medica and 

Therapeutics, Georgetown University ; 
Dr. Wm. C. Gwynn ; 
Mr. Eniile Berliner, and other prominent sanitarians. 

In face of this mass of most authoritative evidence in England, France 
and this country, should not the recommendations as to pasteurization at 
once be heeded and steps taken to eliminate the dangers so imminent in. 
milk? 

In the year 1912, according to the estimates of the National Association 
for the Study and Prevention of Tuberculosis, nearly nineteen million 
dollars ($19,000,000.00) were spent for the support of patients in sani-- 
toria and hospitals. Spend more money to enable health officers to 
secure competent employees to disseminate the importance of safe milk 
throughout the land, and the funds necessary for hospitals, asylums and 
sanitoria, will be decreased rapidly in much greater proportion than the 



17 

initial outlay to add to the efficiency of the efforts of health officers 
A great step will be made towards eradicating the Great White Flagu^, 
which is universally held to be a preventable disease. 

SEPTIC SORE THROAT. 

In the last three or four years Bacteriology has added important addi- 
tional data to the dangers from contaminated milk. 

Repeated outbreaks of virulent sore throat accompanied with high 
mortality have been traced to the presence in milk of a streptococcus. 
This streptococcus may get into the milk from a human source or from 
the presence of streptococci in diseased udders. 

The occurrence of over 600 cases of sore throat in Stockholm in the 
year 1908, was traced to a streptococcus abcess in the udder of a cow 
in a herd that furnished milk to those who became infected. The char- 
acteristics of the two streptococci were identical. 

Since this outbreak in Stockholm careful study has been made of a 
number of such outbreaks in Chicago, Boston and Baltimore. Uniformly 
has the cause been traced to the presence of a streptococcus. It has been 
found that the disease does not stop at the throat. 

Serious diseases of other parts of the body, as the heart, the brain 
and the joints, have been traced as resulting from the throat infection. 

Most exhaustive study was given to the outbreak in Boston in May, 
1911. 

Sedgwick, Winslow, Rosenau, Prescott and many others took part in 
the investigations. The investigation by Winslow was most thorough. 
He found the cause to be a streptococcus, and traced the origin to the 
most carefully conducted dairy in Boston. There were cases of sore 
throat in a family on one of the farms that supplied milk to the dairy 
and also in a family of one of the employees at the dairy. 

These outbreaks of septic sore throat furnish a most powerful argu- 
ment for the pasteurization of the entire milk supply. It is reported that 
now all milk furnished by this dairy in Boston is properly pasteurized in 
the final container. 

The Baltimore epidemic was studied by Dr. Frost, of the Bureau of 
Public Health. He found that this outbreak was also due to a strep- 
tococcus, which survived flash pasteurization. The outbreak ceased as 
soon as proper pasteurization was installed at the dairy plant. 

Much study is now being given to the significance of streptococci in 

milk. 

TYPHOID FEVER. 

Germs of typhoid fever grow with amazing rapidity in milk and soon 
increases the danger arising from this infection of milk. A few germs 
will soon multiply to such an extent that the whole supply with which 
it comes in contact will be contaminated. Mohler and Washburn found 
that the typhoid bacillus survived 21 days in milk kept sweet and 151 
days in butter kept in cold storage. 

This draws attention to the fact that the variety of germs in milk is 
more to be considered than the actual numbers. 



i8 

Typhoid germs enter milk entirely from sources outside of the cow. 
The cow's flank and udder may become infected from the cow having 
waded in streams polluted with the discharges from fever patients 
The washing with cold water of the utensils used in the handling of 
milk is a prolific source of the germs. The fact that typhoid fever is 
eminently a rural disease, occurring two and a-half times more fre- 
quently in the country than in cities, and the known contamination of 
the water supplies of farms, point to the necessity of exercising great care 
to avoid these sources of danger. 

In two counties in Maryland, large milk producing counties for Balti- 
more and Washington, there were 33 deaths from typhoid fever in the 
year 1905. Counting 10 cases to a death, there were 330 cases of typhoid 
fever in these counties — a serious menace to these two cities. 

Everyone is familiar with the common custom, in the country, of 
throwing the discharges of the sick, without proper disinfection, upon 
exposed places, from which they may be washed into the nearby water 
supplies, or permit flies easy access thereto, which carry the germs to 
and infect the pails of milk. 

The milkers and handlers of milk also infect the milk. They frequently 
have the disease for days before being compelled to take to bed. Typhoid 
fever is a disease that is especially spread by germ or bacillus carriers. 
In the fall of 1908 over 50 cases of typhoid fever in Washington, D. C, 
were traced to the supply of milk from a single farm. The owner was 
a bacillus carrier. The supply of milk from this farm was stopped. 

Many reports of outbreaks due to this case have been made in this 
country and Europe, and are being made with increased frequency. 

The contention for pure water, pure milk, and the avoidance of con- 
tact, outlined in 1894, as preventive measures against typhoid fever, is 
further sustained in Bull. 44 of the United States Public Health Service, 
as follows : 

" Thus far our studies indicate that typhoid fever will cease to be a problem in 
any community having clean water, an uninfected milk supply, and in which cases 
of the disease are treated as dangerous and contagious. 

" In drawing up the conclusions and recomm.endations o^f this report, we have 
had the benefit of consultation with the advisory board of the hygienic laboratory, 
composed of eminent scientists and sanitarians." 

ADVISORY BOARD. 

Prof. William H. Welch, Johns Hopkins University, Baltimore, Md. ; 
Prof. Simon Flexner, Rockefeller Institute for Medical Research, New 
York; Prof. Victor C. Vaughan, University of Michigan, Ann Arbor, 
Mich.; Prof. William T. Sedgwick, Massachusetts Institute of Tech- 
nology, Boston, Mass., and Prof. Frank F. Wesbrook. University of 
Minneapolis, Minn,; Lieut. Col. Walter D. McCaw, Surgeon, U. S. 
Army; Medical Inspector E. R. Stitt, U. S. Navy; Dr. A. D. Melvin, 
Chief of U. S. Bureau of Animal Industry, and John F. Anderson, 
U. S. Public Health Service, ex-officio. 



19 
EPIDEMICS TRACED TO THE MILK SUPPLY. 

In May, 1901. Dr. George M. Kober reported a series of 195 epidemics 
of typhoid fever. In 148 of the 195 epidemics of typhoid fever there 
is evidence of the disease existing at the farm. At the same time he 
reported 136 outbreaks of scarlet fever and diphtheria. 

Kober says : 

" It is interesting to note that of the 330 epidemics analyzed bv me 243 have 
been recorded by English authors, 52 by American, 14 by German, 11 by 
Scandniavian, and 5 each by French and Austrian writers. This is probably due 
to the fact that the English and Americans usually consume raw milk, while on the 
Continent the milk is rarely used without being boiled." 

Surgeon Trask, of the United States Public Health and Marine Hos- 
pital Service, in Bulletin 56, has added a large number of similar out- 
breaks to Dr. Kober's list. 

Edward O. Jordan, of Chicago, in an address before Section VI, 
International Congress on Hygiene and Demography, in September, 
1912, has added a large number of similar outbreaks. 

In an interview with Mr. E. Berliner, of Washington, Dr. Heineman, 
the Health Officer of Cassel, Germany, reported the occurrence of over 
300 cases of typhoid fever in the summer of 1909, as the result of the 
use of contaminated raw milk. 

Boston had an outbreak of 1,000 cases of typhoid fever in 1908 from 
a single source of contaminated raw milk. 

In the summer of 1910 nearly 500 cases occurred in Budapest, Hun- 
gary. These were traced to infected raw milk. 

In 1890 there occurred in City of Washington 135 deaths per 100,000 
of population from typhoid, so-called typho-malarial and malarial fever 
combined. It is safe to say that these deaths were nearly all from 
typhoid fever. The population then was nearly 300,000. Assuming 
the usual proportions of 10 cases to one death, there were nearly 4,000 
cases in Washington in 1890. In 1912, with a population of 354,000, 
there were but 585 cases with 78 deaths, giving a ratio of 22 per 100,000 
of population. The diagram prepared for me by the courtesy of Dr. 

Mortality From Typhoid Fever in the 
District of Columbia, 1890 to 191 2, In- 
,^ ^ CLUsivE. Average Annual Death Rate j^^^ ^^ 

lOdoTo 2 Per 100,000 For Five-Year Periods. <''°»°" 




.20 

Woodward, the, Health Officer of the District of Columbia, graphically 
shows the data in regard to this disease. It is interesting to note the 
decrease in mortality after the passage of the Milk Law of 1895 and 
the work of the Milk Conference in 1907. Another factor must be 
considered towards contributing to the drop in mortality since 1901. 
both from typhoid fever and infantile diarrhoea. This factor is the con- 
tinuous publication by Mr. E. Berliner in two of the Sunday papers 
of Bulletins warning of the danger of raw milk and advising home 
pasteurization or the scalding of milk used for infants and invalids. 

This appalling prevalence of typhoid fever and high mortality of 
infants as shown by the census of 1890 prompted me to enlist in the 
campaign for Pure Milk and Pure Water. 

THE GERM WHICH CAUSES THE PREMATURE BIRTH OF A 

DEAD CALF. 

Bacteriology has recently demonstrated that the affection of the dairy 
herd, long recognized as contagious to animals, is the result of a germ 
which has been carefully studied. In addition to causing great loss by 
the birth of dead calves, it has been found that it produces in guinea 
pigs and other animals diseased conditions of their organs, closely re- 
sembling those produced by the germs of tuberculosis. These germs, 
like those of tuberculosis, are found frequently in market milk, without 
any evidence of disease in the herds of cows from which the milk is 
supplied. 

Schroeder, in May, 1911, at the meeting of the Association of American 
Medical Milk Commissions, announced the results of the investigations 
made by him and Cotton. They distinctly described the germ. The work 
was confirmed by Theobald Smith and Fayban. They reported their 
results in January, 1912. 

The discovery of this organism in milk, since there is no prompt method 
of recognizing it, furnishes an additional argument for the proper pas- 
teurization of all milk. It, too, like the other disease-producing germs 
frequently present in milk, is killed when exposed to a temperature of 
140 degrees F. for twenty minutes. 

EFFECTS OF CONTAMINATED MILK UPON INFANTS. 

There is no specific germ that causes malnutrition and the gastro- 
intestinal troubles of infants. It is the general observation that the 
presence of streptococci and colon bacilli in milk does augment these 
disorders. Excessive numbers in milk of any germ, even those at times 
considered to be harmless, has been found also to be productive of these 
troubles. The presence of colon bacilli is the source of great danger to 
children. 

The Ei'FEc'rs of Contaminated Milk have been shown by the preva- 
lence of diarrhoeal diseases and the occurrence of numerous cases of mal- 
nutrition amongst infants raised upon cows' milk. One has but to 
observe the mortality tables during the summer months and compare the 
bacteriological reports of milk ordinarily used for infant feeding to be 
convinced of the direful influence of such milk. 



21 

For more than twenty years philanthropists, sanitarians, physicians 
and others interested in child welfare have been struggling to educate the 
public to the importance of a safe milk supply as the greatest factor in 
the saving of infants' lives. 

The value of an improved milk supply has been strikingly shown in 
Washington since the passage of the Milk Law in 1895, more strikingly 
from 1907, when renewed activity towards the improvement of the milk 
supply was started, and most strikingly in 1912, when again increased 
activities took place. 

. There was a steady improvement in the milk supply in Washington 
from 1895 to 1907, a more marked improvement each year since 1907. 
There has also been a steady diminution in the death rate of children 
under two years of age from diarrhoeal diseases. In 1894, the death rate 
was 190 per 100,000 of population, in 1912 it fell to 53. There is every 
reason to believe that a much lower record would have been secured 
had more attention been given to the character of the milk fed to babies. 



MoRTAUTv From Diarrheal Diseases Under Two Years 
IN the District of Columbia, 1890 to 1912, Inclusive. 
Average Annual Death Rate Per 100,000 For Five- 
«u.t^ Year Periods. «^i 




The diagram prepared by the Health Department plainly shows this 
steady diminution of infant mortality. 

This experience has prevailed whenever and wherever improved con- 
ditions have been secured. During 1912 cleaner milk and better pas- 
teurization were more general in many cities. In New York City 
extraordinary improvements were made. There were nearly 1,000 less 



22 

deaths of infants under one year of age than the year before. Twenty 
per cent, were attributed directly to the better milk supplied at the milk 
stations and by the dealers. In my opinion this estimate is too conserva- 
tive. Supply better milk at once throughout the country and it will be 
seen at the end of the year 1913 that nothing like 300,000 babies will be- 
dead. The experience in Washington coincides with that in New York. 
More heed has been paid to the findings of bacteriology and greater 
efforts have been made to remedy the existing conditions. The progress 
for good from 1895 to 1907 was great, from 1907 to 1912 it was mar- 
velous. The movement for the improvement of the milk supply the worl^d 
over has spread with amazing rapidity. The campaign of education is 
bearing fruit. The benefits of proper pasteurization are now admitted. 
More milk is subjected to the process and far better results are now ob- 
tained by the improved methods. It has been observed that 35 per cent. 
of infants admitted to public institutions die. It is also well known 
that hospitals and public institutions have been exceedingly careless 
about the milk purchased. (See Bulletin 56, Bureau of Public Health, 
pp. 439, et seq.) The experience of milk stations and dispensaries, hos- 
pitals and homes in saving lives, where strict supervision is exercised 
over the raw and pasteurized milk used, should warn those in charge 
of institutions with high mortalities to at once carefully supervise their 
milk supplies. 

HOW MILK CAN BE MADE SAFE. 

Milk should be dean, cold and properly pasteurised. From the data 
furnished in the preceding pages it must be conceded that dairy pro- 
ducts are prolific causes of disease and death. These facts cannot be too 
forcibly nor too frequently brought to the attention of the public. Per- 
sons of high intellectual attainments, and even physicians of superior 
ability, constantly ignore the conditions of the production and the distri- 
bution of the supphes used in their own households, as well as by their 
patients. Instances are many where no efforts have been made to ascer- 
tain the quality of the milk used. 

Milk can be readily made safe by the exercise of common sense and 
ordinary care. 

Milk should be clean, cold and free from disease-producing germs as 
well as an excessive number of other germs. The records of Health 
Departments of up-to-date cities will furnish information upon these 
subjects. These records should be more frequently consulted than they 
are. In some progressive cities they are regularly published in bulletins 
and the daily papers. 

The knowledge of the dangers of milk and the methods of prevention 
should be widely disseminated. 

This dissemination of knowledge should commence in the schools, espe- 
cially in those of rural communities. The value of safe milk 'should 
also be kept before the dwellers in the cities. At the meeting of the 
Association of Medical Milk Commissions held in June, 1910, at St. 
Louis, report was made of the splendid results accomplished at Gales- 
burg, 111., by having students examine in their classes the milk supplied 
to their homes. This example should be followed in every city. 



23 

RESULTS OF INSPECTION OF DAIRIES. 

The authority given by the Milk Law of 1895 for the inspection of 
dairies has produced admirable results from an educational standpoint. 
This inspection has been made the means of acquiring knowledge of 
existing conditions at the farms and dairy depots and of imparting in- 
struction as to the removal of defects and the addition of appropriate 
improvements. Inspection has revealed many unfavorable conditions 
both at the farm and at the city depot. Insanitary houses, milk houses 
and barns were common. The attendants on cattle were careless of their 
personal habits and were frequently sufifering from disease, sometimes 
of a contagious character. Cattle were frequently found covered about 
their flanks, legs, udders and tails with manure and other dirt, which 
readily dropped into the pails while the milking was being done. Cattle 
were many times found to be suffering from constitutional diseases as 
well as local affections of the udder. Flies swarmed about the premises. 
Frequently dead and dying flies floated on the surface of the milk in the 
pails. 

Dr. L. O. Howard, in a publication by the Department of Agriculture, 
suggests that the common house fly be known as the " typhoid fly." Re- 
cent experiences in Wilmington, N. C, and Jacksonville, Florida, justify 
this suggestion. The presence of sediment in the milk containers was a 
common occurrence. This is especially dangerous, since it has been 







Colonies of bacteria transplanted by a fly's feet. 



shown that the ingredients are pus cells, blood, epithelium, barn-yard 
manure, and varied bacteria, including the streptococcus and colon bac- 
illi. Few, if any, facilities were found for boiling the water to clean the 
utensils used in the handling and transportation of milk, the hands of the 
milkers or the udders of the cows. Polluted water readily contaminates 
milk. Heat destroys the pollution. 

A health ofihcj^l of Indianapolis, speaking of inspection, says : 

" While at first we met with serious opposition, producer and dealer have become 
convinced that, instead of persecution, the work is for their betterment. Numbers 



24 

have thanked us for insisting that they improve their conditions, stating that they 
do not see how they could have produced milk under the conditions that they did." 

The experience of Richmond, Va., with inspection has been most 
gratifying. Inspection began in May, 1907.. The average rating of the 
farmers was 41.5 out of a possible 100. But 15 per cent, of tb2 dairies 
scored above 60. In December, 1911, not one was rated below 70. Of 
all supplying Richmond, 07.4 were rated between 80 and 90 ; 5.5 per cent, 
were rated above 90. In his report for 1911 the Health Ofificer says: 

" The inspector has been enabled to give sound practical advice to our dairymen, 
thereby assisting them in many ways. * * * Practically all our dairymen have 
come to regard him as a real friend and helper." 

Washington City also furnishes an excellent illustration of th2 effects 
of intelligent inspection. The inspectors and the producer have learned 
to understand each other. Many of the fanners welcomed the criticisms 
and proceeded to remedy the defects, as it was found that much could 
be done at an insignificant outlay of time and money. Much higher 
ratings were given in many cases on the second inspection. As a result 
of this educational inspection much raw milk is delivered to the dis- 
tributing depots with less than 2,000 bacteria to the cubic centimeter 
and without either streptococci or colon bacilli. 

The President of the Milk Producers Association of Maryland, Vir- 
ginia and the District of Columbia, in one of his addresses, says : " that 
the day was past when the milk inspector was looked upon as an irrecon- 
cilable enemy." Such expressions show the spirit with which intelligent 
inspection is met. The educational inspection means ntuch to both pro- 
ducer and consumer. It contributes not only to the health of the families 
of both, but also to that of the dairy herd. 

THE IMPORTANCE OF THE EXTENSION OF INSPECTION 
AND OF UNIFORM REQUIREMENTS. 

Wherever intelligent inspection has been practiced satisfaction has 
been experienced. 

The American Public Health Association and the Association for the 
Study and Prevention of Infant Mortality at the 1912 meetings passed 
resolutions urging uniform ratings for the results of inspection. 

Many States and cities have diverse requirements. This necessitates 
at times repeated inspections of the same dairy. Milk rejected by one 
city will be received by another with less rigid requirements. Uniform 
requirements exercised by well-trained, competent inspectors would se- 
cure a much more reliable product. Health officials should be qualified 
for their work by proper training. Their tenure of office should be di- 
vorced from politics, as are the United States Government Services. 

THE HEALTH ACTIVITIES OF THE GOVERNMENT ARE 
GREAT FACTORS IN SHOWING HOW SAFE MILK CAN BE 
SECURED. 

A great step forward would be made if more health o^cials and those 
interested in the public health, would avail themselves of the privilege 
to attend the Hygienic Laboratory of the Bureau of Public Health, as 



25 

well as the laboratories of the Department of Agriculture. They would 
soon learn of the health activities of the Government; that these activi- 
ties are against the causes of disease, and for their prevention ; that there 
is no truth in the common slogan that " the sick hog receives more atten- 
tion than the sick woman or child." 

They would find that, in addition to the universally recognized valu- 
able work against disease and death of the Bureau of Public Health, a 
large proportion of the work of the Bureaus of the Department of 
Agriculture is along the same lines ; they would also find that the Medical 
Officers of the Army and Navy are active with the problems of preventive 
medicine. Millions of the money appropriated for the Department of 
Agriculture are expended for purposes bearing directly upon the conser- 
vation of the public health, whilst only thousands are used for diseases 
of animals. They would find skilled officials ready to immediately re- 
spond to calls from State, county and municipal authorities for aid in 
forming plans for education to prevent disease and in repelling invasions 
by disease; that these officials have as willingly laid down their lives in 
battles against disease as have the Army and Navy in attacks upon the 
flag. 

They would also find that Public Act No. 236, approved July 1, 1902, 
" to increase the efficiency and change the name of the Marine Hospital 
Service to the Bureau of Public Health and Marine Hospital Service," 
is an excellent foundation upon which to build a Department of Public 
Health. 

This Act provides for an Advisory Board. The composition of this 
Board, being of eminent scientists and sanitarians from the Federal De- 
partments and civil life, makes the Board authoritative upon public health 
matters. For the names of the present Board see page i8. The section 
providing for this Board was framed with my assistance and was inserted 
at my suggestion. The idea of such a Board was practically endorsed 
in 1909 by a special committee of the National Academy of Sciences, 
appointed at the request of Congress. See special message sent to Congress 
by President Roosevelt January 18, 1909, House Document No. 1337, 
60th Congress, 2d Session. The last section gives power to the President 
to prescribe rules for the conduct of the service. 

The laboratories of the Federal Departments have been the training 
schools for some of the most brilliant teachers, investigators and officials 
of the great universities, colleges, State and municipal governments, as 
well as experts for many private business concerns. Numerous in- 
vestigations in regard to the public health are constantly being con- 
ducted. Authority for additional men in these corps of health workers,, 
and funds for their investigations and the publication of the results of 
these investigations, is imperatively needed. Congress should be gener- 
ous to those branches of the Government service. 

HOW THE HEALTH ACTIVITIES CAN BE GREATLY 
INCREASED. 

Congress, at a very little cost, can immediately multiply the benefits 
of Federal eflforts for the public health without favoring any special school 
of medicine. The causes and the prevention of diseases are factors inde- 



26 

pendent of those points on which different schools of practice disagree. 
The work will soon show such great value that no one will object to an 
additional Department devoted to the public health. Such a department 
should be evolved rather than created. 

The following few provisions would more or less contribute to this 
much needed and desired end : 

Provide for a Committee on Public Health in the House of Represen- 
tatives ; 

Provide that the Advisory Board should be for the Public Health 
Service, not alone for the Hygienic Laboratory, and that they should 
have meetings at certain stated periods of the year ; 

Add to the Board the Chief of the Bureau of Chemistry, who admin- 
isters the Pure Food and Drug Laws ; 

Strike out the ten-day limitation in any one year for their services ; 

Change the compensation for the Advisory Board of ten dollars per 
<lay to an honorarium that would entitle the Government to consult 
them in person or by letter whenever necessary ; 

Provide a School of Instruction for Health Officials of the country, 
after the pattern of the School of Instruction upon Roads provided by the 
Department of Agriculture. The faculty of teachers could be secured 
from the experts of the Government Services ; 

Provide an additional Assistant Secretai-y skilled in Public Health 
Matters. This recommendation has had the endorsement of many prom- 
inent members of the American Medical Association and the Committee 
of One Hundred. 

At the hearings before the Interstate and Foreign Commerce Com- 
mittee of the House of Representatives on Bills relating to the Health 
Activities of the General Government, Miss Mabel Boardman, of \\^ash- 
ington, D. C, member of the Sub-committee on Legislation of the 
■Committee of One Hundred, said : 

"I thought it was unfortunate that when the Department of Agriculture was 
formed it should not have had a much broader scope; that it should have been a 
•department of national resources, and that under seuch a department the human 
resources would have the most prominent importance, because it would be for the 
benefit of the human resources of the country that all other recources were of 
value; that in such a department there should l)e a bureau of public health. * * *" 
(Pages 126 et seq., part II of the Hearings held June 3d, 1911.) 

I heartily endorse her idea that the Bureau of Public Health should be 
an integral part of the Department of Agriculture. This Department is 
now in close touch with the authorities in many of the States and Colonies 
of the country, through its Inspection Services, Experiment Stations and 
Laboratories located therein. Much of the work is related to the Public 
Health. It would be a wise move to transfer the Bureau, preserving its 
autonomy in toto, to the Department of Agriculture, and to appoint an 
Assistant Secretary, skilled in Sanitary Science, to cooperate with the 
Surgeon-General of the Public Health Service. A minor part of the 
duties of the Bureau of Public Health are connected with the Treasury 
Department, hence there is no cogent reason for continuing it in that 
Department. Sanitation is not alluring to the officials of this Department. 
There have been five Assistant Secretaries of the Treasury, in the last four 
years, who have had supervision of the Bureau of Public Health. 



27 



IMPORTANCE OF CLEAN AND COLD MILK. 

CleIan milk can easily be secured by the exercise of care. The meth- 
ods should be now known by everyone. The importance of using the 
hooded milk pail cannot be too forcibly urged. W. A. Stocking, Jr., 
made tests in a stable where but little care was given to cleanliness. 
Under the same conditions lis found the milk drawn in the open pail 
contained 10,317,600 bacteria to the teaspoonful, whilst that drawn in 







the hooded pail contained 310,800. The hooded pail costs but twenty-five 
cents more than the open pail. Dr. Woodward, the Health Officer of 
Washington, so highly appreciates the value of this protected pail, that he 
now allows a rating of 10 for it instead of 1, as he did when he instituted 
the registration of dairies upon caVds known as score cards. The De- 
partment of Agriculture has advanced the rating to 5 points. 

COLD MILK CHECKS THE GROWTH OF GERMS. 

The checking of germs is eminently desirable 
from both sanitary and monetary points of view. 
Diseases arising from germs are avoided. The 
loss of milk by souring, being prevented, insures 
financial return for the entire output. A low 
count of germs, secured by exercising care to 
produce clean milk, is kept almost stationary by 
a temperature at and below ."iO degrees F. To 
secure the best results, milk of each cow must be 
cooled immediately after milking, in a house 
separated from the cow-born, and zvell protected 
from flies by screens. This cooling must be ac- 
complished by pouring milk over coils through 
which running water passes, iced if necessary. 
The placing of large shipping cans of milk in 
receptacles of water is unsatisfactory, from the 
slowness of the process of cooling and the pre- 
vention of the ready escape of contaminating 
odors. Moreover, there is a great danger of 
contamination should stirring be practiced with- 
out the greatest care. An efficient cooler can be 
secured for $15.00 or less. 

All the efforts of the most careful producer 
are nullified unless the milk is transported and 




28 

handled so as to be kept cold and free from dust and dirt. The custom 
of handling milk in ordinary baggage or freight cars without provision for 
refrigeration and allowing it to remain exposed on the station platform tO' 
the rays of the sun and clouds of dust and dirt, favors rapid deterioration. 
The present method of placing milk outside the doors and windows 
of houses hours before occupants are awake is another serious menace. 
It is well worth trying to revolutionize the methods and time of delivering 
milk. If milk could be delivered soon after its arrival at the distributor's 
depot the consumer would secure much fresher milk, at times milk of the 
same day. The large majority of consumers are prepared to properly 
care for it. For it is now recognized that the consumer must contribute 
his effort toward conserving a wholesome milk supply. Milk must be kept 
cold and covered until used. Clean, cold milk furnishes reasonably safe 
milk. 

PASTEURIZATION OF MILK. 

Pasteurization is a term applied to the process of heating milk to 
an appropriate temperature and holding it at that temperature for a 
sufficient time to destroy the disease-producing germs found in milk. 
Ayres has shown that all of the lactic-acid germs, which cause the 
souring of milk, are not destroyed. Pasteurization should not be con- 
fused with sterilization. Sterilization means the destruction of all germs, 
and requires heating to the boiling point on three successive days. The 
term Pasteurization is derived from the experiments made by Pasteur 
for the purpose of preventing the souring of wine and beer. He found 
that temperatures ranging from 122 degrees to 140 degrees F. were 
sufficient to prevent abnormal fermentation in them. The investigations 
of General Sternberg, confirmed repeatedly by investigators of the high- 
e.st authority in Europe and America, have shown that disease-producing 
germs are made harmless by a temperature of 140 degrees maintained 
for 20 minutes or more. It has also been established that this degree of 
heat and time of exposure do not change the taste nor exert any appre- 
ciable deleterious effects upon the nutritive value of milk. This is con- 
clusively shown by Kastle and Roberts, in Bulletin 56, Bureau of Public 
Health. The cream line is not destroyed. It requires a much higher 
temperature to prevent the rising of the cream to the surface, the visual 
test of the richness of the milk. The higher temperatures keep the cream 
mixed with the milk. 

METHODS OF PASTEURIZATION. 

The two methods of pasteurization are the flash and the holding pro- 
cesses. In the flash process the milk is heated to the required tempera- 
ture and held at it for 30 seconds to 1 minute. This is not at all 
satisfactory and should not be allowed. In the holding process the milk 
is heated to 140 degrees or higher, and held at that temperature for 20 
minutes or longer. To insure reliable pasteurization, that is, complete 
destruction of disease-producing germs, progressive milk dealers hold 
the milk at 145 degrees F. for 30 minutes. By the holding process 
properly conducted it is usual to destroy 99.93 to 99.99 per cent, of the 



29 

bacteria. Bulletin 56, Bureau of Public Health, and the records of the 
Health Department of the District of Columbia, show that counts as 
low as 2,000 per cubic centimeter have been secured by this method. 
From the fact that all bacteria are not killed in the process of pasteuriza- 
tion, it is equally as imperative that pasteurized milk,, too, should be 
promptly cooled and kept cold with the same care that raw milk should be 
treated to check the growth of germs. 

The splendid results obtained at infant-milk depots in securing ex- 
ceedingly low counts, where milk has been properly pasteurized in the 
feeding bottles, has drawn attention to the desirability of pasteurizing 
milk in the bottles in which the milk is to be delivered to the consumer. 
This method of pasteurizing in the final container has many points of 
merit. It pasteurizes the bottle at the same time that the milk is pas- 
teurized; it eliminates the possibility of re-infection from the handlers 
of the milk and dust settling upon the surface of the caps. 

Dr. Charles E. North has shown that this process is practical from a 
commercial standpoint. He experimented by placing the milk in bottles, 
capping them with metal caps similar to those used for beer bottles, 
immersing them in water heated to 148 degrees for 15 minutes, and then 
cooling them to below 50 degrees. 

The results obtained were most gratifying. About three-fourths of 
the bottles used showed counts of germs not exceeding 500 to the cubic 
centimeter ; some were as low as 100 ; several were free from germs ; 
the cream line promptly appeared. Ayers, of the Dairy Division, De- 
partment of Agriculture, expresses approbation of this method of pas- 
teurization and is making investigations as to the feasibility of bottling 
and capping milk whilst it is hot. This will enable those who have large 
investments in other machinery to avail themselves of the metal caps. 

IMPORTANCE OF PROPER PASTEURIZATION. 

Experience has taught that the process of pasteurization can not be 
trusted to unskilled and untrained hands. Carelessness at a single point 
in the process may vitiate the entire product of an establishment. The 
Washington Milk Conference in 1907 recognized this fact and earnestly 
advocated the importance of official supervision of pasteurizing plants 
and their outputs. The Conference did not countenance the use of pas- 
teurization to cover up the age nor the dirt in milk. 

Pasteurization was urged as a safeguard against the disease-producing 
germs that have long been known to exist in milk. The world has en- 
dorsed this position. There is not a sanitarian in Washington, in private 
and official life, who does not today demand the proper pasteurization 
of the entire milk supply under official supervision. They do not consent 
to the least abatement of the most rigid requirements for clean milk. 
The heads of six of the great Departments of the Government in Wash- 
ington have endorsed pasteurization by demanding that all milk used 
for lunch by the employees should come under the classification of the 
Washington Milk Conference. 

The Government employees are not able to purchase the high-grade 
raw milk that corresponds to the " Inspected Milk" of the classification 



30 

of the Washington Milk Conference. They are served only " Pasteurized 
Milk." The quality of it is frequently passed upon by the Dairy Division 
of the Bureau of Animal Industry. This Bureau also inspects the butter 
purchased for use by the Navy. The Navy Department requires that 
all butter must be made from pasteurised cream. This action of the six 
Secretaries has greatly aided the campaign of education. The Army 
will soon require standards similar to the Navy. 

Progressive men engaged in the distribution of milk, cream and ice- 
cream in many cities have estabhshed well-equipped pasteurizing plants. 
In order to secure a safe milk they employ skilled bacteriologists. They 
require that their supplies prior to pasteurization, should show a low 
bacterial count and be as free as possible from disease-producing germs. 

It frequently happens that properly pasteurized milk cannot be secured 
on the market. The observance of the following directions for the home 
pasteurization of milk, by L. A. Rogers, of the Bureau of Animal Indus- 
try, can then be practiced : 

" Milk is most conveniently pasteurized in the bottles in which it is delivered. 
To do this use a small pail with a perforated false bottom. An inverted pie-tin 
with a few holes punched in it will answer the purpose. This will raise the bottles 
from the bottom of the pail, thus allowing a free circulation of water and pre- 
venting bumping of the bottles. Punch a hole through the cap of one of the bottles 
and insert a thermometer. The ordinary floating type of thermometer is likely 
to be inaccurate, and if possible a good thermometer with the scale etched on the 
glass should be used. Set the bottles of milk in the pail and fill the pail with 
water nearly to the level of the milk. Put the pail on the stove or over a gas 
flame and heat it until the thermometer in the milk shows not less than 150 nor 
more than 155 F. The bottles should then be removed from the water and allowed 
to stand from twenty to thirty minutes. The temperature will fall slowly, but may 
be held more uniformly by covering the bottles with a towel. The punctured cap 
should be replaced with a new one, or the bottle should be covered with an inverted 
cup. 

" After the milk has been held as directed it should be cooled as quickly and as 
much as possible by setting in water. To avoid danger of breaking the bottle by 
too sudden change of temperature, this water should be warm at first. Replace the 
warm water slowly with cold water. After cooling, milk should in all cases be held 
at the lowest available temperature. 

" This method may be employed to retard the souring of milk or cream for ordi- 
nary uses. It should be remembered, however, that pasteurization does not destroy 
all bacteria in milk, and after pasteurization it should be kept cold and used as 
soon as possible. Cream does not rise as rapidly or separate as completely in pas- 
teurized milk as in raw milk." 

OBJECTIONS TO PASTEURIZATION. 

The objectors have been mostly persons who have not followed the 
developments of recent years. They frequently maintain that pasteur- 
ized milk produces scurvy or rickets. Thousands of children under the 
eyes of careful and competent observers have been reared successfully 
on milk so treated without the slightest signs of scurvy or rickets. 
Rowland G. Freeman has shown that such outbreaks have been traced 
to mixed feeding; that heated milk was an insignificant factor. Hi.s 
observations were strengthened by those of numerous observers in 
Europe. There boiled milk was almost exclusively used. 

In this connection, as many physicians are .still of the opinion that raw 
milk has valuable properties that are destroyed by heat and therefore 



31 

oppose pasteurization, attention is called to a recent publication of the 
Local Government Board on Public Health and Medical Subjects of 
London, in which a summary is given by Dr. E. Janet Lane-Claypon, 
of the " available data in regard to the value of boiled milk as food for 
infants and young animals." In this report, ths following conclusion, 
which is absolutely in harmony with the data obtainable from both ex- 
perimental and clinical observations, is presented. " When an animal 
is fed upon the milk of another species" (which is precisely what is done 
when we feed human babies on cow's milk) " such small differences as 
have been found in the nutritive values of raw and boiled milk have been 
in favor of boiled milk." These observations have been recently con- 
firmed by investigators in Europe and America. 

Boiling milk is going somewhat beyond what is recommended when 
pasteurization is urged. Conditions like scurvy and rickets are shown 
in the report to be related to over-feeding and the use of farinaceous 
food too early in life, but not, as has been claimed again and again with- 
out any satisfactory evidence, to the use of either pasteurized or boiled 
milk. 

GOVERNMENT INVESTIGATION AS TO THE RELATIVE 

\^/\LUE OF RAW AND PASTEURIZED MILK 

FOR INFANT FEEDING. 

This evidence is generally considered conclusive. Yet, in order to 
satisfy the doubters, the Bureau of Public Health and the Bureau of 
Animal Industry have been conducting for over six months, and will 
continue to conduct, an investigation into the Relative Value of Raw 
and Pasteurized Milk for Infant Feeding. 

A STRIKING EXAMPLE OF THE BENEFITS OF MILK 
IMPROVEMENT. 

From the annual report for 1912, of Dr. A. D. Melvin, Chief of the 
Federal Bureau of Animal Industry : 

A remarkable instance of the value of a wholesome milk supply in promoting 
health is afforded by the experience of the past two years at the United States 
Naval Academy, at Annapolis, Md. 

A few years ago, at the request of Paymaster Samuel Bryan, United States 
Navy, who was and is charged with the provisioning of the Naval Academy, the 
bureau tested with tuberculin some of the dairy herds from which milk was 
being obtained under contract. The discovery of tuberculosis in some of the herds, 
together with other bad sanitary conditions, led Paymaster Bryan to undertake 
the establishment of a dairy herd for the Academy. By his request the bureau 
selected the animals for such a herd early in the past fiscal year, and has con- 
tinued to give assistance and supervision in the management of the herd. Since 
October 1, 1911, this herd has been supplying milk to the Academy. For the first 
two months of this period it was necessary to continue a portion of the contract 
supply, but since then the entire supply has been furnished by the Academy herd. 

Paymaster Bryan has compiled figures showing the health of the midshipmen 
for one yeap before and one year since the installation of the Academy herd. 
Taking into account only illness of a digestive or intestinal character, and counting 
each day that a midshipman was sick or excused on this account, it is found that 
during the year from October 1, 1910, to September 30, 1911, with milk from 



32 



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outside sources, the sick days numbered 1,598, or an average of 133 a month; 
while for the following year, with milk from the Academy herd, there were only 
296 (sick days) averaging less than 25 a month. For more than two months 
(including September and October, 1912) there has not been a single case of 
illness of the character mentioned. The number of midshipmen at the Academy 
was practically the same each year, ranging from about 750 for the greater part 
•of the year to about 250 during the summer. The great decrease in illness from 
digestive disturbance is attributed entirely to the better quality of milk, as other 
dietary conditions have remained unchanged." 

The milk at the Naval Academy may now be said to be produced under 
military discipline with the aid of the Scientists of the Department of 
Agriculture. It is a grade of milk that is rarely obtainable by the public 
except at a prohibitive cost. 

CONCLUSION. 



If the lessons taught by these observations be heeded a great step will 
be made toward the control of many preventable diseases and an immedi- 
ate diminution in deaths from tuberculosis, typhoid fever, diphtheria 
and other milk-borne diseases will be secured. The slaughter of infants 
will also be arrested. 

Dollars spent by the hundred for prevention will save millions needed 
for those afflicted with disease, to say nothing of the days of suffering 
and pangs of grief that will be avoided. 

Mothers, arise, and demand with one voice that your physicians and 
law-makers secure safe: milk to save; your babies. 



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